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Women's Experiences of Health Care in Relation to Miscarriage

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Women's Experiences of Health Care in Relation to Miscarriage SAHLGRENSKA AKADEMIN INSTITUTIONEN FÖR VÅRDVETENSKAP OCH HÄLSA WOMEN’S EXPERIENCES OF HEALTH CARE IN RELATION TO MISCARRIAGE Elin Hansson & Jaqueline Niit Uppsats/Examensarbete: 15 hp Program och/eller kurs: Sjuksköterskeprogrammet Nivå: Grundnivå Termin/år: Vt/2016 Handledare: Elisabeth Jangsten Examinator: Zahra Ebrahimi Institutionen för Vårdvetenskap och hälsa Preface We want to thank our mentor Elisabeth Jangsten who has assisted us through the process of writing our Bachelor thesis. Titel (svensk) Kvinnors upplevelse av omvårdnad i samband med missfall Titel (engelsk) Women’s experiences of health care in relation to miscarriage Examensarbete: 15 hp Program och/eller kurs: Sjuksköterskeprogrammet Nivå: Grundnivå Termin/år: Vt/2016 Författare Elin Hansson & Jaqueline Niit Handledare: Elisabeth Jangsten Examinator: Zahra Ebrahimi Summary: Background: Miscarriage is relatively common with one in four pregnancies failing to make it to full term. Previous studies show that women consider a miscarriage as a traumatic experience with many women suffering from grief. Aim: The aim of this paper is to describe the factors that affect women’s experiences of health care provided in relation to miscarriage. Methodology: A literature review was carried out resulting in the analysis of 13 articles. Four themes and eight sub themes emerged as a result of analysis. Result: The four emerging themes are: impact of health care providers’ management of miscarriage, ineffective communication, women’s need for support, and facilitation of the embodiment of grief. The main findings are that there is a lack of information surrounding miscarriage and a lack of psychological support from health care providers. Implications for nursing: A screening of women using scales such as the PGIS and PBGS 6 weeks post-miscarriage are proposed by the authors. Bakgrund: Missfall är relativt vanligt förekommande med en prevalens av 20 %. Tidigare studier har visat att kvinnor upplever missfallet som en traumatisk upplevelse vilken följs av sorg. Syfte: Syftet med denna studie är att beskriva faktorer som påverkar upplevelsen av omvårdnaden i samband med missfall. Metod: En litteraturöversikt genomfördes och resulterade i 13 vetenskapliga artiklar. I analysen framträdde fyra teman och åtta subteman. Result: De fyra teman som framträdde var: inverkan av hälso- och sukvårdspersonalens handläggning av missfall, oeffektiv kommunikation, kvinnors behov av stöd, och underlättandet av sorgarbetet. Implikationer för omvårdnad: Författarna föreslår att man utför screening enligt PGIS och PBGS sex veckor efter missfallet. Nyckelord: Spontaneous abortion, experience, grief, follow-up care Table of contents Introduction ................................................................................................................................ 1 Background ................................................................................................................................ 1 Definition ................................................................................................................................ 1 Demographics ......................................................................................................................... 1 Causes of miscarriage ............................................................................................................. 1 Health care during and after a miscarriage ............................................................................. 2 Women’s experiences of care while going through a miscarriage ......................................... 3 Physical ............................................................................................................................... 3 Psychological ...................................................................................................................... 3 Theoretical framework ........................................................................................................... 5 Swanson’s Theory of Caring .............................................................................................. 5 Problem statement ...................................................................................................................... 5 Aim ............................................................................................................................................. 6 Methodology .............................................................................................................................. 6 Design ..................................................................................................................................... 6 Selection ................................................................................................................................. 6 Analysis .................................................................................................................................. 7 Ethical considerations ............................................................................................................. 7 Author’s preconceptions ......................................................................................................... 8 Result .......................................................................................................................................... 8 Impact of health care providers management of miscarriage ................................................. 8 Quality of health care within the hospital context .............................................................. 8 Availability of follow-up care ............................................................................................. 9 Ineffective communication ................................................................................................... 10 Quality of information provided ....................................................................................... 10 Lack of communication .................................................................................................... 11 Women’s need for support ................................................................................................... 11 Importance of empathy shown by health care providers .................................................. 12 Lack of psychological support .......................................................................................... 13 Facilitation of the embodiment of grief ................................................................................ 13 Acknowledgement of grief ............................................................................................... 13 Enablement of the coping process .................................................................................... 14 Discussion ................................................................................................................................ 14 Methodology ......................................................................................................................... 14 Result .................................................................................................................................... 15 Conclusion ................................................................................................................................ 19 Implications for nursing care .................................................................................................... 19 Further Research ...................................................................................................................... 19 References ................................................................................................................................ 20 Appendix .................................................................................................................................. 23 Introduction We have chosen to immerse ourselves in this topic due to personal encounters with women sharing their stories of undergoing miscarriage. We have received the impression that health care providers do not address the emotional needs of these women. The emotional toll of this experience was apparent and we felt the need to identify factors contributing to these negative experiences. Considering the fact that miscarriages occur as often as one in five pregnancies, the need for further research within this field is apparent. Previous studies have well described women’s experiences of miscarriage. However there is a lack of studies focusing on the quality of health care and how this affects women’s experiences and recovery. The authors intend to focus on care provided in a health care context by nurses and other professional caregivers that women encounter. Background Definition Miscarriage or spontaneous abortion is defined as a pregnancy which has been spontaneously terminated within the first 20 weeks of gestation, where the embryo or fetus and the placenta are expelled from the uterus. The term miscarriage is often used in conversation due to the fact that the word ‘abortion’ is so negatively charged. Miscarriages are often categorized after the gestational age of the aborted fetus; however they can also be categorized by the nature of the miscarriage. Complete/incomplete abortion, septic abortion, inevitable abortion and blighted ovum are examples of how miscarriage can otherwise be categorized (Janson & Landgren., 2015). Demographics The normal
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